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starstrid 06-24-2013 09:43 PM

Slow weight gain. Pediatrician wants us to supplement. Opinions?
Baby is a little over 5 weeks now. Labor/delivery was fine. My milk came in about 5 days postpartum.

Baby was born as 6lbs 7.5oz. She lost weight and dropped down to 5lbs 14oz at her first weekly check-up.

She had an appointment today and her weight is only 6lbs 3.3oz.

The pediatrician was concerned about her slow weight gain. We talked about how I am exclusively breastfeeding. She had me speak with their lactation consultant, as I've also been concerned that perhaps I'm not producing very much milk. I was worried because when I use my breast-pump I'm only getting about 1 oz out, but, of course, I've read on here many times that a pump is not like a baby so it could be very possible that I just don't react to the pump as well as my baby.

The lactation consultant checked the baby for tongue ties and lip ties. Baby was fine. She watched baby nurse and felt that baby may be a lazy nurser.

The plan that she has come up with is as follows:

1. Baby is to have a feeding schedule. Baby will eat every 2 1/2 hours for 20 minutes on each breast.

2. Baby will also take in 2 ounces of formula during each feeding.

3. Baby will be woken up at night at 4 hours, maximum (baby was sleeping soundly all night and not nursing during this time) to be fed.

4. I will pump each breast for 15 minutes after each feeding.

I am wondering what everyone here thinks of this routine. Baby seemed quite full, with a protruding tummy, after a little less than 1 oz of formula. It was a struggle to get her to take the full 2 ounces of formula and she ended up spitting up a bit at the end.

Baby seems more content after this feeding though.

My husband is wondering if our baby might just be small and slower at growth. He is suggesting that we not supplement and let my body and her body do what it would do if let to do what is natural. I'm wondering the same. Our baby was born with a two-vessel cord as well and we are even wondering if this may be why she isn't growing as quickly as the pediatrician has expected from her.


ETA: it may also be interesting to know that she has 6+ heavily wet diapers a day and at least 1 good poop every other day.

evasimone 06-24-2013 11:26 PM

Re: Slow weight gain. Pediatrician wants us to supplement. Opinions?
I think that's way too militant. I agree with waking her after four hours at night and also offering the breast frequently (at least every 2-2.5 hours in the day time). Honestly baby should gain at a minimum 4 oz. per week. So gaining 5 oz. in 5 weeks is not nearly enough so I wouldn't just accept it as normal like your husband suggested because its not. :hugs: I had a baby that wouldn't gain so I am not saying that to be mean, I know how much it hurts when you are working really hard.

I think you should pay attention to your baby's cues. I think militantly forcing your baby to nurse 20 minutes or eat 2 oz. is a mistake. If your baby is happy after an ounce don't push another. If babe falls asleep on the second breast after 5 minutes don't keep pushing him to nurse more.

If you supplement you'll have to pump to keep your supply up. A lactaid SNS might be a good choice for you. You can supplement your babe while they are nursing so you'll get the stimulation and babe will still get the supplement.

EmilytheStrange 06-24-2013 11:35 PM

I would add night nursing sessions and see how that changes things. Too little gain to sleep that long. And make sure its so often during the day. But I think I would try that before supplementing. And I wouldn't force 2oz of formula.

I would also get baby weighed before and after a nursing session to see how much they're taking. 2oz a feeding total is enough. 2 oz after 40 min of nursing?? Yeah.. That doesn't sound right for that age and size. Sounds like too much and I'm not surprised baby spit it back up.

I think dad has the right idea. But would be nice to know how many oz baby is nursing to see if he's really on track.

evasimone 06-24-2013 11:55 PM

Re: Slow weight gain. Pediatrician wants us to supplement. Opinions?
Yeah Emilythestrange is right that 2 oz. after a feeding is a huge amount. Not to mention if you breast feed 10 times a day and supplement everytime after that's 20 oz. just from supplementing alone which is a massive quantity. Most likely if you up your nursing sessions to two during the night your babe should start gaining.

I also second a pre and post feed weigh. Their are a lot of hospitals that offer free support groups where you can speak with a LC and weigh your baby.

crunchycrossfitmamaof2++ 06-25-2013 04:34 AM

I disagree with scheduling a 5 week old. my daughter was born at 7.11, dropped down to 7.5, and only got up to 7.9 by week 1. she's 4 months now and we're just realizing she's a tall skinny baby. if she's eating good, I'd keep doing it your way.

let her comfort nurse too, instead of a paci. it will help boost your supply. t

spencerrn 06-25-2013 05:10 AM

Re: Slow weight gain. Pediatrician wants us to supplement. Opinions?
You absolutely need to supplement until you can get your supply up and get her gaining. She should have been near her birth weight by 2 weeks. She is 5 weeks and still below birth weight. That is very concerning.

I think you plan sounds good, 2 ounces after every feeding does seem like a lot but you are trying to make up for growth she should have done already. I wouldn't push her to finish the whole 2 ounces but I would definitely offer it. I think an SNS would be a great idea!

If you do not have a double electric hospital grade pump, I would either invest in one or rent one until you can get this supply problem resolved.

Hang in there. You can do this and it will work.

evasimone 06-25-2013 07:40 AM

Re: Slow weight gain. Pediatrician wants us to supplement. Opinions?
I came back to this post to also say that I ended up doing something similar with my daughter at 3 months except I did it without the support of an IBCLC. She had fallen off the WHO weight charts and was just a miserable baby and was a lethargic, fussy feeder.

I wasn't militant about it but it worked. I just want to warn you that once your baby starts gaining she will most likely go through a ravenous period where she is STARVING. My dd would howl like she was being tortured when her milk ran out (we'd give her more). But it was quite the change from the baby that was content to starve. So don't be surprised if your baby acts desperately hungry for a few weeks until she gets where she needs to be.

The one thing I wish I had done was use an Supplemental nursing system because supplementing that frequently wrecked our already tenuous nursing relationship because my babe started associating my breast with frustration and basically refused it.

Please don't let that scare you away from supplementing though, your babe is hungry and quite underweight. I'd just highly recommend a SNS.

Kquiet 06-25-2013 02:53 PM

Re: Slow weight gain. Pediatrician wants us to supplement. Opinions?
Sounds excessive to me :( my babies were slow gainers, too. I hated when they wanted me to "make" them eat. Yeah, right! I let my babes eat as long as they could on ONE side to get as much of the rich hind milk as they could, change them to wake them up and offer the other side. After they were finished I would pump the breast they ate the longest on for 15 min. I always leave the other breast in case they want to eat again before 2 hrs. I never supplemented w/formula. Sometimes just the expressed breast milk. I feel like they live at my breasts, but they gain weight!

EmilytheStrange 06-25-2013 03:04 PM

On the hindmilk note, you can work on making your milk fattier. An IBCLC or your pediatrician might have a machine that can determine the fat/calorie content of your milk and see if it shows room for improvement.

Until then, lots of avocados, cheesecake, etc.

miriamleigh 06-25-2013 08:54 PM

Re: Slow weight gain. Pediatrician wants us to supplement. Opinions?
Something very similar happened to me with my DD2. She didn't make her birth weight till 4 weeks. Basically I was underfeeding her. It was a vicious cycle of her not eating enough and then getting too weak to nurse and sleeping more and not waking up to nurse. Once we figured out the problem it was easy to get her back on track. So it could be that your baby needs a little formula or extra breastmilk so she perks up and eats more. BTW, I also took fenugreek and it increased my supply dramatically.

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